Healthcare Provider Details

I. General information

NPI: 1205097607
Provider Name (Legal Business Name): MICHAEL PETER WEISBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 EAST WEST ROAD
CALUMET CITY IL
60409
US

IV. Provider business mailing address

1700 EAST WEST ROAD
CALUMET CITY IL
60409
US

V. Phone/Fax

Practice location:
  • Phone: 708-891-3330
  • Fax: 708-891-0904
Mailing address:
  • Phone: 708-891-3330
  • Fax: 708-891-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number241050
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-123299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: